| NPI | 1871689042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: WI 42713) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 1507) |
| 207Q00000X Family Medicine (Licence: WI 42713) | |
| 207Q00000X Family Medicine (Licence: MI 5101009742) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2013-07-01 |